Inpatient and Outpatient Specialty Care Clinical Pathway to Triage Tonsillectomy and/or Adenotonsillectomy Patients with or without Preoperative Polysomnography

Child Undergoing Tonsillectomy and/or Adenotonsillectomy with or without Pre-Operative Polysomnography
 
 
  • Comorbid conditions that increase risk for complications intra/postoperatively
  • Consider sleep study
    • Down syndrome
    • Craniofacial anomalies
    • Neuromuscular disease
    • Chronic lung disease
    • Sickle cell disease
    • Metabolic disease
    • BMI ≥ 95th percentile
 
 
  Ambulatory Surgical Center (ASC) KOPH PHL Day Surgery PHL
Age
Comorbid Conditions
  • ≥ 3.5 yrs
  • Comorbid conditions cleared
    by Anesthesia
  • > 3 yrs
  • No known difficult airway
  • No diabetes mellitus
  • > 3 yrs
  • No comorbid conditions
  • All patients < 3 yr or
    > 3 yrs with comorbid conditions
  • BMI > 35
Selection Criteria    
Polysomnography Results
  • AHI > 23 and
  • High-risk gas exchange concerns
    • Peak CO2 ≥ 60, O2 nadir ≤ 85
  • AHI 0-23 and
  • No high-risk gas exchange concerns
    • Peak CO2 ≤ 60, O2 nadir ≥ 85
  • AHI > 23 and
  • High-risk gas exchange concerns
    • Peak CO2 ≥ 60, O2 nadir ≤ 85
Ambulatory Surgery Center
PHL or KOPH Day Surgery
PHL or KOPH Inpatient
 
 
 
 
 
 
Post-Surgery/Perianesthesia Care Unit
Determine Disposition
 
 
 
 
 
 
Inpatient Surgical Unit
PICU
 
 
 
 
Posted: July 2016
Last Revised: March 2025